Coronary Artery Stenting Affects Wall Shear Stress Topological Skeleton

2022 ◽  
Author(s):  
Claudio Chiastra ◽  
Valentina Mazzi ◽  
Maurizio Lodi Rizzini ◽  
Karol Calò ◽  
Anna Corti ◽  
...  
Keyword(s):  
Shear Stress ◽  
Coronary Artery ◽  
Wall Shear Stress ◽  
Vascular Diseases ◽  
Human Coronary Artery ◽  
Term Outcome ◽  
Clinical Images ◽  
Long Term Outcome ◽  
Wall Shear ◽  
The Impact

Abstract Despite the important advancements in the stent technology for the treatment of diseased coronary arteries, major complications still affect the post-operative long-term outcome. The stent-induced flow disturbances, and especially the altered wall shear stress (WSS) profile at the strut level, play an important role in the pathophysiological mechanisms leading to stent thrombosis (ST) and in-stent restenosis (ISR). In this context, the analysis of the WSS topological skeleton is gaining more and more interest by extending the current understanding of the association between local hemodynamics and vascular diseases. The present study aims to analyze the impact that a deployed coronary stent has on the WSS topological skeleton. Computational fluid dynamics simulations were performed in three stented human coronary artery geometries reconstructed from clinical images. The selected cases presented stents with different designs (i.e., two contemporary drug eluting stents and one bioresorbable scaffold) and included regions with stent malapposition or overlapping. A recently proposed Eulerian-based approach was applied to analyze the WSS topological skeleton features. The results highlighted that the presence of single or multiple stents within a coronary artery markedly impacts the WSS topological skeleton. In particular, repetitive patterns of WSS divergence were observed at the luminal surface, highlighting a WSS contraction action proximal to the struts and a WSS expansion action distal to the struts. This WSS action pattern was independent from the stent design. In conclusions, these findings could contribute to a deeper understanding of the hemodynamic-driven processes underlying ST and ISR.

Plaque Progression in a Human Coronary Artery is Associated With Low Wall Shear Stress and Extended Particle Residence Time

2010 ◽  
Author(s):  
Jin Suo ◽  
Michael McDaniel ◽  
Parham Eshtehardi ◽  
Saurabh Dhawan ◽  
Ravi Prasad Avati Nanjundappa ◽  
...  
Keyword(s):  
Shear Stress ◽  
Coronary Artery ◽  
Wall Shear Stress ◽  
Residence Time ◽  
Vigorous Physical Activity ◽  
Region Of Interest ◽  
Reconstruction Technique ◽  
Plaque Progression ◽  
Human Coronary Artery ◽  
Wall Shear

Intravascular ultrasound (IVUS) evaluation was performed in the coronary arteries of a 45-year-old patient with stable angina during vigorous physical activity. Concurrent angiography demonstrated a mild plaque in the proximal left anterior descending artery (LAD), with obvious lumen dilatation immediately distal to the plaque. Blood velocity was measured by a catheter Doppler transducer at proximal and distal segments of the left coronary artery, and the left main artery (LM) and LAD were reconstructed using a 3D-IVUS reconstruction technique based on biplanar angiography and IVUS images, enabling simulation of the flow field in the artery employing computational fluid dynamics (CFD). Wall shear stress (WSS) and particle path lines were determined from the CFD studies. The patient returned for a follow up evaluation after 6 months, and plaque progression during this period was evaluated from the IVUS data. Results showed that low WSS, less than 5 dynes/cm2, which occurs in the region immediately distal to the plaque, correlates with localized progression of the lesion over the 6 month interval. The path line tracking computations showed that particles near the vessel surface where plaque progression was observed resided near the artery wall longer than one complete cardiac cycle, whereas in other areas particles were flushed through the region of interest rapidly. These observations in a specific individual are consistent with the hypothesis that plaque progression is related to low WSS and relatively long residence time of atherogenic blood-borne substances.

scholarly journals Impact of Competitive Flow on Hemodynamics in Coronary Surgery: Numerical Study of ITA-LAD Model

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Jinli Ding ◽  
Youjun Liu ◽  
Feng Wang ◽  
Fan Bai
Keyword(s):  
Shear Stress ◽  
Coronary Artery ◽  
Wall Shear Stress ◽  
Numerical Study ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Coronary Artery Bypass Grafts ◽  
Wall Shear ◽  
The Impact

Competitive flow from native coronary artery is considered as a major factor in the failure of the coronary artery bypass grafts. However, the physiological effects are not very clear. The aim is to research the impact of competitive flow caused by different left anterior descending (LAD) artery stenosis degrees on hemodynamics in internal thoracic artery (ITA) bypass graft. An idealized ITA-LAD model was built in CAD tools. The degree of the competitive flow was divided into five classes according to different LAD stenosis degrees: higher (no stenosis), secondary (30% stenosis), reduced (50% stenosis), lower (75% stenosis) and no competitive flow (fully stenosis). Finite volume method was employed for the numerical simulation. The flow velocity distributions, wall shear stress and oscillatory shear index were analyzed. Results showed that higher competitive flow in the bypass graft would produce unbeneficial wall shear stress distribution associating with endothelial dysfunction and subsequent graft failure. The coronary bypass graft surgery was preferred to be carried out when the LAD stenosis was higher than 75%.

P3588The synergistic effect of NIRS-detected lipid-rich plaque and 5 different multidirectional wall shear stress metrics on human coronary plaque growth

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E M J Hartman ◽  
A M Kok ◽  
A Hoogendoorn ◽  
F J H Gijsen ◽  
A F W Steen ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Synergistic Effect ◽  
Coronary Arteries ◽  
Wall Thickness ◽  
Plaque Progression ◽  
Lipid Rich Plaque ◽  
Plaque Growth ◽  
Wall Shear ◽  
The Impact

Abstract Introduction Local wall shear stress (WSS) metrics, high local lipid levels (as detected by near-infrared spectroscopy (NIRS)), as well as systemic lipid levels, have been individually associated with atherosclerotic disease progression. However, a possible synergistic effect remains to be elucidated. This study is the first study to combine WSS metrics with NIRS-detected local lipid content to investigate a potential synergistic effect on plaque progression in human coronary arteries. Methods The IMPACT study is a prospective, single centre study investigating the relation between atherosclerotic plaque progression and WSS in human coronary arteries. Patients with ACS treated with PCI were included. At baseline and after 1-year follow-up, patients underwent near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) imaging and intravascular doppler flow measurements of at least one non-culprit coronary artery. After one month, a CT angiography was made. CT derived centreline combined with IVUS lumen contours resulted in a 3D reconstruction of the vessel. The following WSS metrics were computed using computational fluid dynamics applying the vessel specific invasive flow measurements: time-average wall shear stress (TAWSS), relative residence time (RRT), cross-flow index, oscillatory shear index and transverse wall shear stress. Low TAWSS is known as pro atherogenic, in contrast to all the other shear stress metrics, at which a high magnitude is pro-atherogenic. The arteries were divided into 1.5mm/45° sectors. Based on NIRS-IVUS, wall thickness change over time was determined and NIRS positive sectors detected. Furthermore, per vessel the shear stress was divided into tertiles (low, intermediate, high). To investigate the synergistic effect of local lipids on shear stress related plaque growth, wall thickness change over time was related to the different shear stress metrics comparing the NIRS-positive with the NIRS-negative sectors. Results 15 non-culprit coronary arteries from the first 14 patients were analyzed (age 62±10 years old and 92.9% male). A total of 2219 sectors were studied (5.2%, N=130, NIRS-positive) for wall thickness changes. After studying all five shear stress metrics, we found for TAWSS and RRT that presence of lipids, as detected by NIRS, amplified the effect of shear stress on plaque progression (see figure). Sectors presenting with lipid-rich plaque, compared to NIRS-negative sectors, showed more progression when they were exposed to low TAWSS (p=0.07) or high RRT (p=0.012) and more regression in sectors exposed to high TAWSS (p=0.10) or low RRT (p=0.06). Delta wall thickness vs shear stress Conclusion We presented the first preliminary results of the IMPACT study, showing the synergistic effect of lipid rich plaque and shear stress on plaque progression. Therefore, intravascular lipid-rich plaque (NIRS) assessment has added value to shear stress profiling for the prediction of plaque growth, leading to improved risk stratification. Acknowledgement/Funding ERC starting grant 310457

scholarly journals Psychological profiles derived by cluster analysis of Minnesota Multiphasic Personality Inventory and long term clinical outcome after coronary artery by pass grafting

2015 ◽  
Vol 78 (1) ◽  
Author(s):  
Maddalena Modica ◽  
Roberta Carabalona ◽  
Rosa Spezzaferri ◽  
Monica Tavanelli ◽  
A. Torri ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Coronary Artery ◽  
Clinical Characteristics ◽  
Minnesota Multiphasic Personality Inventory ◽  
Personality Inventory ◽  
Psychological Characteristics ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The Impact

Background: To evaluate the psychological characteristics of coronary heart disease (CHD) patients after coronary artery bypass grafting (CABG) by cluster analysis of Minnesota Multiphasic Personality Inventory (MMPI-2) questionnaires and to assess the impact of the profiles obtained on long-term outcome. Methods: 229 CHD patients admitted to cardiac rehabilitation filled in self-administered MMPI-2 questionnaires early after CABG. We assessed the relation between MMPI- 2 profiles derived by cluster analysis, clinical characteristics and outcome at 3-year follow-up. Results: Among the 215 patients (76% men, median age 66 years) with valid criteria in control scales, we identified 3 clusters (G) with homogenous psychological characteristics: G1 patients (N=75) presented somatoform complaints but overall minimal psychological distress. G2 patients (N=72) presented type D personality traits. G3 subjects (N=68) showed a trend to cynicism, mild increases in anger, social introversion and hostility. Clusters overlapped for clinical characteristics such as smoking (G1 21%, G2 24%, G3 24%, p ns), previous myocardial infarction (G1 43%, G2 47%, G3 49% p ns), LV ejection fraction (G1 60 [51 – 60]; G2 58 [49- 60]; G3 60 [55-60], p ns), 3-vessel-disease prevalence (G1 69%, G2 65%, G3 71%, p ns). Three-year event rates were comparable (G1 15%; G2 18%; G3 15%) and Kaplan- Meier curves overlapped among clusters (p ns). Conclusions: After CABG, the interpretation of MMPI- 2 by cluster analysis is useful for the psychological and personological diagnosis to direct psychological assistance. Conversely, results from cluster analysis of MMPI-2 do not seem helpful to the clinician to predict long term outcome.

scholarly journals Intimal Thickness Is not Associated With Wall Shear Stress Patterns in the Human Right Coronary Artery

2004 ◽  
Vol 24 (12) ◽  
pp. 2408-2413 ◽  
Author(s):  
Anil K. Joshi ◽  
Richard L. Leask ◽  
Jerry G. Myers ◽  
Matadial Ojha ◽  
Jagdish Butany ◽  
...  
Keyword(s):  
Shear Stress ◽  
Coronary Artery ◽  
Wall Shear Stress ◽  
Right Coronary Artery ◽  
Human Right ◽  
Intimal Thickness ◽  
Wall Shear ◽  
Stress Patterns

scholarly journals Numerical Simulation of Dispersed Particle-Blood Flow in the Stenosed Coronary Arteries

2018 ◽  
Vol 2018 ◽  
pp. 1-16 ◽  
Author(s):  
Mongkol Kaewbumrung ◽  
Somsak Orankitjaroen ◽  
Pichit Boonkrong ◽  
Buraskorn Nuntadilok ◽  
Benchawan Wiwatanapataphee
Keyword(s):  
Numerical Simulation ◽  
Blood Flow ◽  
Shear Stress ◽  
Coronary Artery ◽  
Pressure Drop ◽  
Wall Shear Stress ◽  
Stokes Equations ◽  
Spherical Shape ◽  
Shear Stresses ◽  
Wall Shear

A mathematical model of dispersed bioparticle-blood flow through the stenosed coronary artery under the pulsatile boundary conditions is proposed. Blood is assumed to be an incompressible non-Newtonian fluid and its flow is considered as turbulence described by the Reynolds-averaged Navier-Stokes equations. Bioparticles are assumed to be spherical shape with the same density as blood, and their translation and rotational motions are governed by Newtonian equations. Impact of particle movement on the blood velocity, the pressure distribution, and the wall shear stress distribution in three different severity degrees of stenosis including 25%, 50%, and 75% are investigated through the numerical simulation using ANSYS 18.2. Increasing degree of stenosis severity results in higher values of the pressure drop and wall shear stresses. The higher level of bioparticle motion directly varies with the pressure drop and wall shear stress. The area of coronary artery with higher density of bioparticles also presents the higher wall shear stress.

Preliminary Near Wall Hemodynamic Evaluation of a Coronary Artery Bypass Graft Model With a Flow Streamlining Implant

2002 ◽  
Author(s):  
Pedro D. Pedroso ◽  
Andreas S. Anayiotos ◽  
Brad L. Hershey ◽  
Evangelos Eleftheriou ◽  
William L. Holman
Keyword(s):  
Shear Stress ◽  
Coronary Artery ◽  
Wall Shear Stress ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Saphenous Vein ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Wall Shear

Coronary artery disease (CAD) is the leading cause of death in the world today. According to the American Heart Association 529,659 people in 1999 died as a result of CAD [1]. Starting in the 1960’s, surgeons have used Coronary Artery Bypass Graft (CABG) techniques in order to reestablish blood flow to the heart. Today, the procedure remains the same, using autologous grafts, such as the mammary artery and the saphenous vein. An unresolved problem, is that a significant number of CABGs reocclude months to years postoperatively. In the case of Saphenous Vein Grafts (SVGs) typically 50% of these bypasses are totally occluded months to years after the procedure, the remaining half being more than 50% occluded [2]. The re-occlusion of CABGs is due to a process labeled intimal hyperplasia (IH). Investigators have shown that IH, believed by some to be a remodeling process, occurs at branch sites, regions of curvature, and anastomotic junctions [3,4]. At these sites there are low residence times, slow secondary structures, disturbed flow, and areas of recirculation, therefore the onset of IH is believed to be hemodynamically linked. Most recently, floor IH has been attributed to four variables: time averaged wall shear stress (WSS), oscillating shear index (OSI), spatial wall shear stress gradients (WSSG), and temporal WSSG [5]. Adverse values of these parameters, in the case of SVGs, are believed to be caused by impedance mismatch at the anastomosis site. Over time this characteristic causes a bulge at the sinus. Such a morphology additionally contributes to disturbed flows which tend to propagate down the CABG and are believed to play a major role in the development of IH and the eventual failure of the graft.

Analysis of Flow and Wall Shear Stress in Curvature Induced Dorsal Aneurysms: Effect of Arterial Curvature

2009 ◽  
Author(s):  
Arun Ramu ◽  
Guo-Xiang Wang
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Fluid Dynamic ◽  
Cerebral Arteries ◽  
Cerebral Aneurysms ◽  
Morbidity Rate ◽  
Mortality And Morbidity ◽  
Wall Shear ◽  
Primary Velocity ◽  
The Impact

Intracranial aneurysms are abnormal enlargement in the walls of cerebral arteries. The rupture of aneurysms is the leading cause of subarachnoid hemorrhage (SAH), with a high mortality and morbidity rate. A majority of saccular cerebral aneurysms occur at sites of arterial bifurcations. However, a good percentage of aneurysms are curvature induced and are found along the cavernous arterial segment. The occurrence of such non branching aneurysms, clinically called dorsal aneurysms, can be related to the increased wall shear stress at the curved arteries. The rupture of aneurysms usually occurs at the dome region, which is subjected to reduced wall shear stress (wss) owing to low re-circulating flow. Hence it is important to understand the impact of arterial curvature on the WSS distribution along the dome of aneurysms. Previously, studies have not taken into account the aspect of low WSS along the dome region. In the present 3-d computational fluid dynamic approach, we investigate the impact of varying arterial curvature on spherical dorsal aneurysms. The primary velocity patterns, the WSS distribution along the dome of the aneurysm and the area of increased WSS have been quantified for steady flow conditions.

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